Surgeon Dr. Donatas Danys, wielding a scalpel for 14 years and performing obesity surgeries for at least five, reveals that post-treatment, some patients are unrecognizable. Their health not only improves, but life itself takes on new hues. However, the surgeon laments that in Lithuania, not all recognize the dangers and chronic illnesses caused by this condition.

Some not only fail to regard obesity as a serious illness but also wrongly label it as laziness – suggesting that those individuals are simply lazy, unable to stop eating. D. Danys consistently endeavors to dispel this myth and emphasizes that typically, those on the surgical table are those who have endured long and arduous journeys battling excessive weight.

In an interview with portal tv3.lt, abdominal surgeon and medical doctor Donatas Danys discusses the scale and causes of obesity in today’s world, excessive consumerism, and surgical approaches to combatting obesity.

The scale of obese and overweight individuals is alarmingly on the rise. What’s the situation in Lithuania – is everything just heading downhill?

Obesity as a disease is highly prevalent, and on a global scale, Lithuania neither leads nor lags behind. It’s estimated that obesity is prevalent among about 20 percent of people, with the disease showing an increasing trend worldwide; in various countries, figures can range from 20 to 30 percent. But generally, it’s considered that more than one in five individuals is obese. Of course, the highest figures are in the United States, where every third person has a body mass index (BMI) greater than 30. We, on the other hand, align with the European level, but the prevalence of the disease continues to increase, and today, every fifth of our residents struggles with obesity. Unfortunately, we are following global trends hand in hand.

Obesity – not just due to excess food

Typically, we imagine an obese person as someone who eats a lot, whose diet is dominated by unhealthy food, and who doesn’t exercise much. So, are lifestyle factors the biggest culprits for obesity?

Obesity is influenced by many factors. One reason is genetic, as if we see that grandparents or parents had this problem, then children are predisposed to obesity. But this isn’t a rule; lifestyle still has the greatest impact. And it’s not just about food, but also about the inappropriate choices, frequent snacking. The lion’s share consists of a complex of several elements – diet, physical activity, stress, sleep quality, as well as the environment that surrounds us. These are the fundamental criteria that most often determine whether weight tends to increase or remains high and difficult to lose in the long term.

So, sometimes a person can eat well, but if there’s a lot of stress, little sleep – there will be problems with weight?

Absolutely. That’s why when treatment begins, dietitians prescribe a diet, but if there’s not enough insight into lifestyle habits, the surrounding environment, there may not be any results. Perhaps there’s a bad example in the family, encouraging snacking, maybe there’s night work, others experience very high stress at work, and then they unconsciously overeat, emotional eating occurs when a person calms down and becomes happier only after satisfying their hunger. Others say they don’t eat anything because they don’t even feel hungry. So whichever specialist – a dietitian, surgeon, nutrition specialist, family doctor – treats obesity, they must comprehensively consider the environment surrounding the individual, why a particular person has a higher BMI.

You mentioned the importance of sleep – is both the duration and quality of sleep important here?

Sleep allows the body to rest. If a person doesn’t get enough sleep – only four hours or works night shifts, automatically the quality of sleep is completely different, there’s no deep sleep, there’s wakefulness, and sleep deprivation leads to constant fatigue. An unrested body reacts differently – all its defense mechanisms shut down, so the patient automatically feels more inclined to eat, snack more often, such people are more prone to sleepiness, they’re tired. As a result, their lifestyle becomes more sedentary, they consume more food.

Apparently, there’s no point in talking about alcohol, as it has a negative impact on weight regulation.

Alcohol poses a significant risk, especially if, as is often the case, it’s consumed with very fatty food. If there’s some celebration, high-calorie snacks are consumed, and that doesn’t lead to anything good.

At the surgeon’s office – after enduring hardships

As I understand it, obesity isn’t diagnosed ‘at a glance’; the main indicator is precisely the BMI?

That’s a very old but reliable criterion. Of course, it’s not a verdict, because if we’re talking about an athlete with a lot of muscle, we wouldn’t consider them obese, even if their BMI is over 30. Such people don’t usually come to us. We’re talking about people who struggle with overweight, excessive weight that interferes with their lives. Then BMI, which is body weight divided by height squared, is very important. When it exceeds 30, we already consider it as first-degree obesity, which is a disease. Overweight is considered when BMI is between 25 and 30, and a normal body mass index is between 18 and 25. As our weight increases, BMI reaches over 30, 40, 50, 60, it’s already super obesity. There are patients whose BMI is even 80 or more. BMI simply helps us gauge the severity of the problem, and then we assess associated diseases, of which there can be several with obesity – such as diabetes, heart and vascular diseases, and others.

When do these patients knock on the surgeon’s door?

There are many ways to treat obesity, and it’s not like we can prescribe a standardized treatment scheme based on a certain BMI size. Initially, we try to define the cause of the disorder. When it’s usually a lifestyle-related disorder, with the help of a dietitian, sometimes even a psychotherapist, after lifestyle adjustments, we can lose 10, 15, 20 kilograms.

However, when weight loss attempts fail, the person is referred to specialist doctors – it could be a consultation with a surgeon, if there are endocrine problems – to an endocrinologist. But if the body mass index is very high, over 40, the most suitable treatment is surgical. So when the patient has already tried everything themselves – changing physical activity, dietary habits, lifestyle, and maybe even prescribed medication, if that doesn’t work, the last resort is surgery.

Do you also see very young severely obese people?

People come in from 18 years old, as well as older adults, over 40, 30. But there are also those in their 20s, 22s, the youngest, of course, are 18-year-olds who come barely reaching adulthood or next time their parents bring them and say they have problems they want to solve.

These days, our stomachs are truly too large

In layman’s terms, the surgeries we’re talking about are usually called gastric reduction. What are the most common treatment methods included in this definition today?

There are several different surgeries – currently, the most widely used worldwide are two types of surgeries. They are both equally effective but have different indications depending on the patient’s disorders, accompanying diseases. If there’s a very high BMI and we have severe reflux, metabolic disorders, there’s an endocrine disease, we opt for, you could say, a more drastic metabolic surgery – that’s a gastric bypass surgery. We show patients a picture of what the intestines will look like, we reconstruct it – during the surgery, we form a small one from a large stomach and bypass part of the intestines, it doesn’t participate in the digestive tract. Another commonly performed surgery is gastric resection, during which we don’t change anything, we just significantly reduce the stomach – remove about 80 percent of it. This is the first-choice surgery, unless there are more accompanying diseases, then we choose gastric bypass surgery. These surgeries are safe, lasting 1–1.5 hours, depending on the complexity of the person. And if you saw from the side how those small incisions look afterwards – that’s the achievement of our time when we can operate through tiny keyhole-like openings, reduce the stomach, and help treat obesity. And during both types of surgery, the stomach decreases drastically – about 80–85 percent. Of course, it may sound drastic to the patient, but physiologically, that’s entirely sufficient for us to be able to eat normally, live, and not have significant side effects. These days, our stomachs are truly too large. Consumption, consumption, consumption – today we not only test various services as consumers but also receive various food offers on every corner, we can eat a lot without stopping, without leaving the room, get the tastiest food delivered home – pizza, burgers, and so on.

It’s paradoxical, but food excess – the bane of our civilization?

Yes, that’s the Western way of life, and that’s the problem. When the stomach is small, we don’t want to eat so much, and we quickly feel satisfied after starting to eat.

If a person feels that their fat content has increased, clothes start to feel tight, movement becomes harder, perhaps here we shouldn’t talk about such drastic surgeries?

We always evaluate not only BMI but also the type of obesity – whether it’s visceral, what causes it, where fat is distributed more. But if there’s overweight, BMI isn’t high or it’s only first-degree obesity, we can offer not only a dietitian’s or medication treatment but also an intragastric balloon. Then, without any major surgeries, a balloon is implanted into the stomach, reducing its volume, and thus our fat can melt away – within about half a year, body mass can be reduced by 10–15 percent.

There are also endoscopic gastric folding surgeries, where the stomach volume is also drastically reduced. But when BMI exceeds 35, 40, even these less invasive methods are less effective than surgery.

Losing 50–60 kg after surgery – a common indicator

It’s probably mistaken to think that lying down on the operating table is always the easiest path.

It certainly isn’t. Those who don’t face such a problem are slimmer, with a normal BMI, and think that surgical treatment is the easiest way out. Almost as if they just pressed a button and their stomach shrunk. It’s not like that – it’s one of the tougher paths. Rarely does anyone come for consultation without having tried to deal with their weight in some way. They come precisely to tell how for years they’ve struggled, trying to lose weight in various ways – intermittent fasting, various diets, advice from a sports trainer. They are already exhausted, and a visit to the surgeon is often the last resort. People usually think about it for half a year, a year; it’s not a spontaneous decision. So the person has a lot to go through before and after the surgery. Later, it’s very important to monitor what’s eaten because not all hard-to-digest food may be tolerated. So these are surgeries done for the sake of health, which result not only in weight loss but, which is very important, also improve the person’s health regarding accompanying diseases. Those diseases regress – blood sugar levels are regulated, diabetes regresses, blood pressure control improves. Movement becomes completely different; if before the person couldn’t climb to the 3rd floor, after surgery, they can easily climb to the 5th floor and even higher. Movement also provides a desire to socialize, to show oneself. We see those patients on social media too; they want to share, show how they looked before and after surgery. When patients come for consultations after 6 months, we often don’t even recognize them, because people change drastically – not only their body but also their face, features. When you lose 50, 70 kilograms, those are huge changes.

Do you remember the most kilograms your patient has lost?

There’s a case where a patient has lost more than 100 kilograms, of course, he’s tall, weighed over 200 kg. Usually, 50–60 kg is a common indicator of what we can expect to lose in the years following the surgery. Of course, it depends on how big the patient was. If a woman weighs 100 kg, it won’t be that she’ll lose 60 kg, as that wouldn’t be healthy anymore. The essential thing is that the changes are very significant. But it’s not cosmetic; it’s a therapeutic surgery for obesity.

 

You mentioned that food tolerance generally changes after surgery. Does this reduce the risk of relapse?

The risk of returning to a high weight isn’t high, but some patients do return because they start consuming liquid high-calorie foods, snacking, which can lead to weight regain. But often when the stomach is small and one tries to consume very calorie-dense, fatty, spicy food, the patient doesn’t tolerate it well. After trying such unhealthy food, they automatically don’t want it again. Most patients actually start to really like various fibrous substances – vegetables, salads, fish products, chicken. And all of this already sounds like healthier food.

Are such surgeries covered by the state?

Perhaps someday in Lithuania they will be fully covered, but for now, they are only partially covered. Patients suffering from obesity are numerous, and we need to do something about it internally; we don’t have room among the fats. That’s why there are special instruments that help us a lot – they save surgery time, speed up the process, and make it safer. These instruments are very expensive, and unfortunately, the state doesn’t cover them. So, these surgeries are partially covered, and patients who want to be operated on as quickly as possible fall into the non-compensated group. Such surgeries are three times more expensive than partially compensated ones. But overall, compared to America, European countries, even the United Arab Emirates, the price-to-quality ratio in our country is very high.

Are there many people who want to be treated for obesity in this way, or maybe some are afraid?

In Lithuania, there aren’t many surgeons who perform such operations because it’s complicated. We’d count about 10 surgeons specializing in this field throughout Lithuania. Operations in state institutions are performed about 500–700 times per year. The numbers for private practice aren’t precisely known, but there’s a high demand for such operations. Of course, not all patients want this – ask someone from your family next time if they know about such treatment; they’ll probably say they don’t know and don’t want to know.

How did you get into this field?

Being a surgeon is physically very demanding – not only do you need to know a lot, but you also need skills. These surgeries in abdominal surgery are probably some of the most complicated. But I’ve always been fascinated by challenges, difficult, interesting surgeries, significant changes. It’s also continuous improvement, learning. For many years, I mainly performed colorectal surgeries for treating oncological diseases, but then somehow gradually transitioned to the area I chose, or maybe it chose me. Because when you end up where you enjoy what you do, you automatically want to continue improving, striving, and helping others fight obesity.

Have you encountered the stereotypical view that you’re just “trimming” people, reducing bellies, without doing anything serious?

That it’s a disease is still not well understood by people in Lithuania. But I certainly don’t just “trim” – that’s what plastic surgeons do (smiles). They do major reconstructive plastic surgeries more for aesthetic purposes. We only help patients get back on the right track in terms of nutrition. So, there’s no need to come to us for beautification, but for treatment. Of course, more women seek help for obesity, so some of them, as their BMI decreases, consider such surgery not only necessary for health but also important aesthetically. Others receive much more attention and really want to show themselves in public. One of the recent stories is when a patient lost 50 kilograms in six months and came complaining that her husband doesn’t recognize her anymore (laughs). She says she’s so much more beautiful now, even before the wedding she wasn’t like this. It needs to be understood that this changes not only the lives of the individuals themselves but also those of their loved ones. As I mentioned, eating habits and lifestyles change, so men really need to make an effort because women change drastically in appearance.

The article was first published on 13.04.2024 in the regional platform tv3.lt by Aigustė Tavoraitė. You can find the original version here.